title: What provokes experienced COPD clinical practitioners in the UK to initiate or change medication? A consensus study.
abstract: BACKGROUND
  In the absence of clarity in national guidelines, this study aimed to reach a consensus among experts in chronic obstructive pulmonary disease (COPD) regarding when medication should be initiated or changed in patients demonstrating a gradual decline.
  
  
  METHODS
  An electronic three-stage Delphi exercise was undertaken with 37 leading UK experts in COPD. The panel submitted criteria which they scored in subsequent rounds. Consensus was defined as ≥ 80% of the panel scoring an item as important.
  
  
  RESULTS
  Consensus was reached on seven criteria: decreased exercise tolerance (97%); increased breathlessness at rest or on exertion (97%); quality of life impairment (91%); low or reduced oxygen saturations based on pulse oximetry readings (86%); ability to perform activities of daily living independently (85%); increase in sputum (80%); and increase in wheeze (80%).
  
  
  CONCLUSIONS
  These criteria could be used to guide clinical practice. Empirical research is now required to test their reliability and validity.
authors.affiliation: Education for Health, Warwick, Warwickshire, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Upton
authors.forename: Ellen
authors.initials: E
authors.lastname: McCutcheon
authors.forename: Christine
authors.initials: C
authors.lastname: Loveridge
authors.forename: John
authors.initials: J
authors.lastname: Wiggins
authors.forename: Samantha
authors.initials: S
authors.lastname: Walker
authors.forename: Monica
authors.initials: M
authors.lastname: Fletcher
mesh_terms: D000203:Activities of Daily Living; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002983:Clinical Competence; D032921:Consensus; D011307:Drug Prescriptions / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D015203:Reproducibility of Results; D006113:United Kingdom
chemical_list: D001993:Bronchodilator Agents